Percutaneous ultrasound-guided coaxial core needle biopsy for the diagnosis of multiple splenic lesions: A case report

BACKGROUND The overlap of imaging manifestations among distinct splenic lesions gives rise to a diagnostic dilemma.Consequently,a definitive diagnosis primarily relies on his-tological results.The ultrasound(US)-guided coaxial core needle biopsy(CNB)not only procures sufficient tissue to help clarify the diagnosis,but reduces the incidence of puncture-related complications.CASE SUMMARY A 41-year-old female,with a history of pulmonary tuberculosis,was admitted to our hospital with multiple indeterminate splenic lesions.Gray-scale ultrasono-graphy demonstrated splenomegaly with numerous well-defined hypoechoic ma-sses.Abdominal contrast-enhanced computed tomography(CT)showed an en-larged spleen with multiple irregular-shaped,peripherally enhancing,hypodense lesions.Positron emission CT revealed numerous abnormal hyperglycemia foci.These imaging findings strongly indicated the possibility of infectious disease as the primary concern,with neoplastic lesions requiring exclusion.To obtain the precise pathological diagnosis,the US-guided coaxial CNB of the spleen was ca-rried out.The patient did not express any discomfort during the procedure.CONCLUSION Percutaneous US-guided coaxial CNB is an excellent and safe option for obtaining precise splenic tissue samples,as it significantly enhances sample yield for exact pathological analysis with minimum trauma to the spleen parenchyma and sur-rounding tissue.

Efficacy of contrast-enhanced ultrasound-guided percutaneous core needle biopsy in anterior mediastinal masses

Objective:To evaluate the efficacy and safety of percutaneous core needle biopsy(PCNB)using ultrasound(US)-guided and contrast-enhanced ultrasound(CEUS)-guided procedures for anterior mediastinal masses(AMMs).Methods:In total,284 consecutive patients(166 men,118 women;mean age,43.0±18.4 years)who underwent PCNB for AMMs were enrolled.Patients were divided into the US-guided group(n=133)and the CEUS-guided group(n=151).PCNB was performed using a core needle(16-gauge or 18-gauge).Internal necrosis,diagnostic yield,and diagnostic accuracy were compared between the two groups.Results:The predominant final diagnosis of the cases in this study was thymoma(29.7%),lymphoma(20.5%),thymic carcinoma(13.3%),and germ cell tumour(13.3%),respectively.There was no significant difference in patient age,sex,number of percutaneous biopsies,or display rate of internal necrosis on conventional US between the two groups.The rate of internal necrosis of the lesions was significantly higher after contrast agent injection(72.2%vs.41.7%;P<0.001).The CEUS-guided group had a higher diagnostic yield than the US-guided group(100%vs.89.5%,P<0.001).There was no significant difference between the diagnostic accuracy of the CEUSguided and US-guided groups(97.3%vs.97.4%;P=1.000).None of the patients experienced adverse reactions or complications after US-guided or CEUS-guided PCNB.Conclusions:CEUS-guided PCNB can improve the diagnostic yield by optimizing the biopsy procedure.

Breast Core-Needle Biopsy in a Large Tertiary Oncologic Centre—1-Year Experience after the Introduction of the Method

Ultrasound (US)-guided core-needle biopsy (CNB) is currently the procedure of choice for work-up of suspicious breast lesion. It is mainly used for evaluation of suspicious breast lesions categorized as BI-RADS 4 and 5 (Breast Imaging-Reporting and Data System). The conducted study included 56 female patients with detected suspicious breast leasions, and they underwent US-guided CNB during 1-year period with the aim to investigate the value of US-guided CNB of the breast in a tertiary-level large-volume oncological centre setting with respect of indications, technical adequacy and safety. 2 patients who entered the study were previously diagnosed as BIRADS 2, 3 patients as BIRADS 3, 18 patients as BIRADS 4 and 33 patients as BIRADS 5. In 14 patients with BC (breast cancer), both FNA (fine-needle aspiration) and CNB were performed, and the malignancy was accurately diagnosed by cytology in 9 patients, confirmed by subsequent CNB in all of them. ADH (atypical ductal hyperplasia) was initialy diagnosed by FNA in 5 patients, and in 2 of them, BC was initialy missed by FNA, but deteced by CNB. As it is known, the cytology has lower sensitivity for detection of BC than hystology, with false-negative rate ranging from 2.5% to 17.9%. In our material, 18.7% of carcinomas were initialy left undetected by FNAC, and subsequently confirmed by CNB. All confirmed carcinomas were correctly suspected on imaging, and categorized as BI-RADS 4 or 5, while all BI-RADS 2 and 3 findings were confirmed as benign on hystology. False-positive rate of imaging was 8%. An average number of 4 tissue cores (range: 2 - 7) was taken in our experience if good quality of the first 3 core was achieved, and there was no consistent reason to proceed with sampling.

Transperineal core-needle biopsy of a rectal subepithelial lesion guided by endorectal ultrasound after contrast-enhanced ultrasound: A case report

BACKGROUND Rectal subepithelial lesions(SELs) are commonly seen in endoscopic examination, generally manifested as bumps with a smooth surface. Precise preoperative diagnoses for rectal SELs are difficult because abnormal tissues are not easily to be obtained by regular endoscopic forceps biopsy. Traditional guidance modalities of preoperative biopsy, including endoscopic ultrasound, computed tomography, and transabdominal ultrasound, are often unsatisfactory. An updated, safe, and effective biopsy guidance method is required. We herein report a new biopsy guidance modality—endorectal ultrasound(ERUS) combined with contrastenhanced ultrasound(CEUS).CASE SUMMARY A 32-year-old woman complained of a mass inside the rectovaginal space for 9 years, which became enlarged within 1 year. A rectal SEL detected by endoscopy was suspected to be a gastrointestinal stromal tumor or exophytic uterine fibroid. Pathological diagnosis was difficult because of unsuccessful transabdominal core needle biopsy with insufficient tissues, as well as vaginal hemorrhage. A second biopsy was suggested after multiple disciplinary treatment discussion, which referred to a transperineal core needle biopsy(CNB) guided by ERUS combined with CEUS. Adequate samples were procured and rectal gastrointestinal stromal tumor was proved to be the pathological diagnosis. Imatinib was recommended for first-line therapy by multiple disciplinary treatment discussion. After the tumor shrunk, resection of the rectal gastrointestinal stromal tumor was performed through the posterior vaginal wall. Adjuvant therapy was applied and no recurrence or metastasis has been found by the last follow-up on December 13, 2019.CONCLUSION Transperineal CNB guided by ERUS and CEUS is a safe and effective preoperative biopsy of rectal SELs yet with some limitations.

Ultrasound-Guided Core Needle Biopsy of Breast Lesions: Results and Usefulness in a Low Income Country

Background: Core needle biopsy (CNB) under ultrasound guidance is an accepted standard of care for the diagnosis of breast lesions. It is safe, cost-effective and minimally invasive compared with surgical excision. Objective: The aim of this study was to evaluate the CNB’s results regarding the procedure, complications, histopathological findings and their correlation with the imaging data and surgical histopathological findings. Method: A cross-sectional prospective and descriptive study of a consecutive series of ultrasound-guided CNB of breast lesions in women conduced from January 2015 to December 2016 at the Sylvanus Olympio university hospital of Lomé, in Togo. Results: There were 72 CNB performed under ultrasound guidance in women;from which 54 were retained for the study. The mean age was 44.9 years ± 9.8. 11.1% had a family history of breast cancer. Lesions were most often palpable (90.7%). They were located in the left breast in 54.7%. Lesions were categorized probably malignant or malignant (Birads 4 and 5) in 70.4% and probably benign (Birads 3) in 29.6%. Their mean size was 24.8 mm ± 7.6 at ultrasound. There were no major complications during the procedure. One CNB (1.9%) considered inconclusive was repeated. Histologically, invasive ductal carcinoma (61.1%) was the most common lesion. Fifty-three women underwent surgical procedure and histopathological confirmation. Ultrasound-guided CNB had a sensitivity of 97.5%, specificity of 100%, positive predictive value of 100%, negative predictive value of 92.8%, and an overall diagnostic accuracy of 98.1%. Breast Imaging Reporting and Data System (Birads) categorization had a sensitivity of 94.8%, specificity of 100%, positive predictive value of 100%, negative predictive value of 87.4%, and diagnostic accuracy of 96.2%. Conclusion: Ultrasound guided CNB represent accurate methods for the characterization of breast lesions, with high values of diagnostic accuracy, sensitivity, specificity and negative predictive value. It does not involve a major complication, even in tropical environments.

Favorable Reproducibility of Ki-67-Labeling Index between Core Needle Biopsy and Surgical Materials in Mammary Carcinoma: Reproducibility Influenced by Hot Spots, a High Ki-67 Labeling Index, and the Total Length of Biopsy Material

Aims: The reproducibility of Ki-67 between core-needle biopsies and surgical materials has not been well documented in the literature, although the concordance affects the utility of the Ki-67 labeling index based on the core-needle biopsy materials, which indicates the need for preoperative chemotherapy. The aim of this study was to reveal the reproducibility of Ki-67 between both materials and the cause of discrepancies. Methods and Results: We analyzed 137 cases of invasive carcinoma of the breast and the compared Ki-67-labeling index between core-needle biopsy and surgical materials. The Ki-67-labeling index of biopsy and surgical specimens ranged from 1% to 85% (median: 13%) and 1% to 80% (median: 12%), respectively. The discrepancy of Ki-67-labeling ranged from 0% to 55% (median: 4%) and could be calculated by the tumor size, hot spots of surgical materials, a high Ki-67-labeling index based on the core-needle biopsy materials, and the total length of core needles, respectively. Conclusions: The concordance rate of the Ki-67-labeling index between core-needle biopsies and surgical materials was favorable, so we can use each Ki-67-labeling index of core-needle biopsies as a marker for preoperative chemotherapy. Factors affecting the index discrepancy were hot spots, a high Ki-67-labeling index, and the total length of biopsy material. Judgements on the subtypes and clinical procedures of invasive breast carcinoma could be made comprehensively based on not only the Ki-67-labeling index but also the existence of hot spots and histological grade.

Is sentinel lymph node biopsy necessary for the patients diagnosed with breast ductal carcinoma in situ using core needle biopsy or vacuum-assisted biopsy as the initial diagnostic method？

Objective: Axillary lymph node status is one of the most important prognostic indicator of survival for breast cancer, especially in ductal carcinoma in situ(DCIS). The purpose of this study was to investigate whether sentinel lymph node biopsy(SLNB) should be performed in patients with an initial diagnosis of DCIS. Methods: A retrospective study was performed of 124 patients with an initial diagnosis of DCIS between March 2000 and June 2014. The patients were treated with either SLNB or axillary node dissection during the surgery, and we compared the clinicopathologic characteristics, image features, and immunohistochemical results. Results: Eighty-two patients(66.1%) had pure DCIS and 25(20.2%) had DCIS with microinvasion(DCISM), 17(13.7%) updated to invasive breast cancer(IBC). 115 patients(92.7%) underwent SLNB, among them, 70 patients(56.5%) underwent axillary node dissection. 3 of 115 patients(2.6%) had a positive sentinel lymph node, only 1(1.4%) of 70 patients had axillary lymph node metastasis, in 84 patients(66.7%) who were diagnosed DCIS by core needle biopsy(CNB) and vacuum-assisted biopsy(VAB). 26 patients(31.0%) were upstaged into IBC or DCISM in the final histological diagnosis. The statistically significant factors predictive of underestimation were large tumor size, microcalcifications, comedo necrosis, positive Her-2 status, negative estrogen receptor status. Conclusion: The metastasis of sentinel lymph nodes in pure DCIS is very low, but the underestimation of invasive carcinoma in patients with an initial diagnosis of DCIS is an usual incident, especially in the cases when DCIS is diagnosed by CNB or VAB. Our findings suggest patients presenting with a preoperative diagnosis of DCIS associated with large tumor sizes, microcalcifications, comedo necrosis, positive Her-2 status, negative ER status are more likely to be DCISM and IBC in final diagnosis. SLNB should be performed in this part of patients.

Is there a difference between 19G core biopsy needle and 22G core biopsy needle in diagnosing the correct etiology?——A meta-analysis and systematic review

AIM To compare the accuracy of endoscopic ultra-sonography(EUS) 19 G core biopsies and 22 G core biopsies in diagnosing the correct etiology for a solid mass.METHODS Articles were searched in Medline, Pub Med, and Ovid journals. Pooling was conducted by both fixed and random effects models. RESULTS Initial search identified 4460 reference articles for 19 G and 22 G, of these 670 relevant articles were selected and reviewed. Data was extracted from 6 studies for 19G(n = 289) and 16 studies for 22G(n = 592) which met the inclusion criteria. EUS 19 G core biopsies had a pooled sensitivity of 91.6%(95%CI: 87.1-95.0) and pooled specificity of 95.9%(95%CI: 88.6-99.2), whereas EUS 22 G had a pooled sensitivity of 83.3%(95%CI: 79.7-86.6) and pooled specificity of 64.3%(95%CI: 54.7-73.1). The positive likelihood ratio of EUS 19 G core biopsies was 9.08(95%CI: 1.12-73.66) and EUS 22 G core biopsies was 1.99(95%CI: 1.09-3.66).The negative likelihood ratio of EUS 19 G core biopsies was 0.12(95%CI: 0.07-0.24) and EUS 22 G core biopsies was 0.25(95%CI: 0.14-0.41). The diagnostic odds ratio was 84.74(95%CI: 18.31-392.26) for 19 G core biopsies and 10.55(95% CI: 3.29-33.87) for 22 G needles. CONCLUSION EUS 19 G core biopsies have an excellent diagnostic value and seem to be better than EUS 22 G biopsies in detecting the correct etiology for a solid mass.

Factors associated with upstaging in patients preoperatively diagnosed with ductal carcinoma in situ by core needle biopsy

Objective: Patients preoperatively diagnosed with ductal carcinoma in situ(DCIS) by core needle biopsy(CNB) exhibit a significant risk for upstaging on final pathology, which leads to major concerns of whether axillary staging is required at the primary operation. The present study aimed to identify clinicopathological factors associated with upstaging in patients preoperatively diagnosed with DCIS by CNB.Methods: The present study enrolled 604 patients(cN0 M0) with a preoperative diagnosis of pure DCIS by CNB, who underwent axillary staging between August 2006 and December 2015, at Fudan University Shanghai Cancer Center(Shanghai, China).Predictive factors of upstaging were analyzed retrospectively.Results: Of the 604 patients, 20.03%(n = 121) and 31.95%(n = 193) were upstaged to DCIS with microinvasion(DCISM) and invasive breast cancer(IBC) on final pathology, respectively. Larger tumor size on ultrasonography(> 2 cm) was independently associated with upstaging [odds ratio(OR) 1.558, P = 0.014]. Additionally, patients in lower breast imaging reporting and data system(BI-RADS) categories were less likely to be upstaged(4 B vs. 5: OR 0.435, P = 0.002;4 C vs. 5: OR 0.502, P = 0.001). Overall,axillary metastasis occurred in 6.79%(n = 41) of patients. Among patients with axillary metastasis, 1.38%(4/290), 3.31%(4/121)and 17.10%(33/193) were in the DCIS, DCISM, and IBC groups, respectively.Conclusions: For patients initially diagnosed with DCIS by CNB, larger tumor size on ultrasonography(> 2 cm) and higher BIRADS category were independent predictive factors of upstaging on final pathology. Thus, axillary staging in patients with smaller tumor sizes and lower BI-RADS category may be omitted, with little downstream risk for upstaging.

Histopathological characteristics of needle core biopsy and surgical specimens from patients with solitary hepatocellular carcinoma or intrahepatic cholangiocarcinoma

BACKGROUND Pathological manifestations of hepatic tumours are often associated with prognosis. Although surgical specimens(SS) can provide more information,currently, pre-treatment needle core biopsy(NCB) is increasingly showing important value in understanding the nature of liver tumors and even in diagnosis and treatment decisions. However, the concordance of the clinicopathological characteristics and immunohistochemical(IHC) staining between NCB and SS from patients with hepatic tumours were less concerned.AIM To introduce a more accurate method for interpreting the IHC staining results in order to improve the diagnostic value of hepatic malignancy in NCB samples.METHOD A total of 208 patients who underwent both preoperative NCB and surgical resection for hepatocellular carcinoma(HCC) or intrahepatic cholangiocarcinomaRESULTS Morphologically, the presence of compact tumour nests or a cord-like structure in NCB was considered the primary cause of misdiagnosis of HCC from ICC. The kappa statistic showed a moderate agreement in histomorphology(k = 0.504) and histological grade(k = 0.488) between NCB and SS of the tumours. A 4-tier(+++,++, +, and-) scoring scheme that emphasized the focal neoplastic cell immunoreactivity of tumour cells revealed perfect concordance of CK19, GPC3 and HepPar1 between NCB and SS(k = 0.717; k = 0.768; k = 0.633). Furthermore,with the aid of a binary classification derived from the 4-tier score, a high concordance was achieved in interpreting the IHC staining of the three markers between NCB and final SS(k = 0.931; k = 0.907; k = 0.803), increasing the accuracy of NCB diagnosis C(k = 0.987; area under the curve = 0.997, 95%CI: 0.990-1.000; P< 0.001).CONCLUSION These findings imply that reasonable interpretation of IHC results in NCB is vital for improving the accuracy of tumour diagnosis. The simplified binary classification provides an easy and applicable approach.

Phase II Clinical Study of Three-Dimensional Printed Coplanar Template Combined with CT-Guided Percutaneous Core Needle Biopsy of Pulmonary Nodules in Elderly Patients

Background: As the population age structure gradually ages, more and more elderly people were found to have pulmonary nodules during physical examinations. Most elderly people had underlying diseases such as heart, lung, brain and blood vessels and cannot tolerate surgery. Computed tomography (CT)-guided percutaneous core needle biopsy (CNB) was the first choice for pathological diagnosis and subsequent targeted drugs, immune drugs or ablation treatment. CT-guided percutaneous CNB requires clinicians with rich CNB experience to ensure high CNB accuracy, but it was easy to cause complications such as pneumothorax and hemorrhage. Three-dimensional (3D) printing coplanar template (PCT) combined with CT-guided percutaneous pulmonary CNB biopsy has been used in clinical practice, but there was no prospective, randomized controlled study. Methods: Elderly patients with lung nodules admitted to the Department of Oncology of our hospital from January 2019 to January 2023 were selected. A total of 225 elderly patients were screened, and 30 patients were included after screening. They were randomly divided into experimental group (Group A: 30 cases) and control group (Group B: 30 cases). Group A was given 3D-PCT combined with CT-guided percutaneous pulmonary CNB biopsy, Group B underwent CT-guided percutaneous pulmonary CNB. The primary outcome measure of this study was the accuracy of diagnostic CNB, and the secondary outcome measures were CNB time, number of CNB needles, number of pathological tissues and complications. Results: The diagnostic accuracy of group A and group B was 96.67% and 76.67%, respectively (P = 0.026). There were statistical differences between group A and group B in average CNB time (P = 0.001), number of CNB (1 vs more than 1, P = 0.029), and pathological tissue obtained by CNB (3 vs 1, P = 0.040). There was no statistical difference in the incidence of pneumothorax and hemorrhage between the two groups (P > 0.05). Conclusions: 3D-PCT combined with CT-guided percutaneous CNB can improve the puncture accuracy of elderly patients, shorten the puncture time, reduce the number of punctures, and increase the amount of puncture pathological tissue, without increasing pneumothorax and hemorrhage complications. We look forward to verifying this in a phase III randomized controlled clinical study. .

The Significance of Minimally Invasive Core Needle Biopsy and Immunohistochemistry Analysis in 235 Cases with Breast Lesions

OBJECTIVE To evaluate core needle biopsy (CNB) as a mini-mally invasive method to examine breast lesions and discuss theclinical significance of subsequent immunohistochemistry (IHC)analysis.METHODS The clinical data and pathological results of 235 pa-tients with breast lesions, who received CNB before surgery, wereanalyzed and compared. Based on the results of CNB done beforesurgery, 87 out of 204 patients diagnosed as invasive carcinomawere subjected to immunodetection for p53, c-erbB-2, ER and PR.The morphological change of cancer tissues in response to chemo-therapy was also evaluated.RESULTS In total of 235 cases receiving CNB examination, 204were diagnosed as invasive carcinoma, reaching a 100% consistentrate with the surgical diagnosis. Sixty percent of the cases diag-nosed as non-invasive carcinoma by CNB was identified to havethe presence of invading elements in surgical specimens, and simi-larly, 50% of the cases diagnosed as atypical ductal hyperplasia byCNB was confirmed to be carcinoma by the subsequent result ofexcision biopsy. There was no significant difference between theCNB biopsy and regular surgical samples in positive rate of im-munohistochemistry analysis (p53, c-erbB-2, ER and PR; P >0.05).However, there was significant difference in the expression rate ofp53 and c-erbB-2 between the cases with and without morphologi-cal change in response to chemotherapy (P < 0.05). In most caseswith p53 and c-erbB-2 positive, there was no obvious morphologi-cal change after chemotherapy.CONCLUSION CNB is a cost-effective diagnostic method withminimal invasion for breast lesions, although it still has some limi-tations. Immunodetection on CNB tissue is expected to have greatsignificance in clinical applications.

Endoscopic ultrasound guided liver biopsy: Recent evidence

Liver biopsy(LB)is an essential tool in diagnosing,evaluating and managing various diseases of the liver.As such,histopathological results are critical as they establish or aid in diagnosis,provide information on prognosis,and guide the appropriate selection of medical therapy for patients.Indications for LB include evaluation of persistent elevation of liver chemistries of unclear etiology,diagnosis of chronic liver diseases such as Wilson's disease,autoimmune hepatitis,small duct primary sclerosing cholangitis,work up of fever of unknown origin,amyloidosis and more.Traditionally,methods of acquiring liver tissue have included percutaneous LB(PCLB),transjugular LB(TJLB)or biopsy taken surgically via laparotomy or laparoscopy.However,traditional methods of LB may be inferior to newer methods.Additionally,PCLB and TJLB carry higher risks of adverse events and complications.More recently,endoscopic ultrasound guided LB(EUS-LB)has evolved as an alternative method of tissue sampling that has proven to be safe and effective,with limited adverse events.Compared to PC and TJ routes,EUS-LB may also have a greater diagnostic yield of tissue,be superior for a targeted approach of focal lesions,provide higher quality images and allow for greater patient comfort.These advantages have contributed to the increased use of EUS-LB as a technique for obtaining liver tissue.Herein,we provide a review of the recent evidence of EUS-LB for liver disease.

Percutaneous liver biopsy： retrospective study of primary and secondary hepatic lymphoma in twenty-one patients

BACKGROUND： Hepatic lymphoma （HL） is categorized as primary and secondary hepatic lymphoma （PHL and SHL）. This disorder can present as hepatic mass or mass-like lesion. Chemotherapy often is the first line treatment for patients with HL. Thus, an accurate pre-management histological diagnosis is essential to potentially improve clinical outcomes. The present study was to explore the prevalence of HL in ultrasound guided liver biopsies for hepatic mass or mass-like lesions, to investigate HL associated clinicopathological features, to raise the awareness of early recognition and proper diagnosis of this entity, and to assess specimen adequacy in needle core biopsy. METHODS： Twenty-one cases of HL were enrolled. Clinical and pathological characteristics were evaluated, quality of biopsies was assessed and pertinent literature was reviewed. RESULTS： HL was diagnosed in 0.94% of 2242 liver biopsy cases with ambiguous clinical presentation, laboratory tests and image studies. There were two cases of PHL （0.09%）, and nineteen cases of SHL （0.85%）. Histopathologically, diffuse large B-cell lymphoma was the most common type, followed by B-cell lymphoma not otherwise specified, T-ceU lymphoma, Hodgkin＇s lymphoma, and B-cell chronic lymphocytic leukemia/small lymphocytic lymphoma. Additionally, three lym- phocytic infiltration patterns were documented microscopically. The nodular infiltration was the most common type. CONCLUSIONS： HL is a rare entity and histopathology along with ancillary tests remains the only way to make the diagnosis.Clinicians＇ awareness of this entity and early liver biopsy are essential in patient management.

Management of Intraductal Papilloma of the Breast Diagnosed on Core Needle Biopsy:Latest Controversies

Intraductal papillomas(IDPs),including central papilloma and peripheral papilloma,are common in the female population.Due to the lack of specific clinical manifestations of IDPs,it is easy to misdiagnose or miss diagnose.The difficulty of dif-ferential diagnosis using imaging techniques also contributes to these conditions.Histopathology is the gold standard for the diagnosis of IDPs while the possibility of under sample exists in the percutaneous biopsy.There have been some debates about how to treat asymptomatic IDPs without atypia diagnosed on core needle biopsy(CNB),especially when the upgrade rate to carcinoma is considered.This article concludes that further surgery is recommended for IDPs without atypia diagnosed on CNB who have high-risk factors,while appropriate imaging follow-up may be suitable for those without risk factors.

Biopsy of parotid masses:Review of current techniques

Definitive diagnosis of parotid gland masses is required optimal management planning and for prognosis. There is controversy over whether fine needle aspiration cytology(FNAC) or ultrasound guided core biopsy(USCB) should be the standard for obtaining a biopsy. The aim of this review is to assess the current evidence available to assess the benefits of each technique and also to assess the use of intra-operative frozen section(IOFS). Literature searches were performed using pubmed and google scholar. The literature has been reviewed and the evidence is presented. FNAC is an accepted and widely used technique. It has been shown to have variable diagnostic capabilities depending on centres and experience of staff. USCB has a highly consistent diagnostic accuracy and can help with tumour grading and staging. However, the technique is more invasive and there is a question regarding potential for seeding. Furthermore, USCB is less likely to be offered as part of a one-stop clinic. IOFS has no role as a first line diagnostic technique but may be reserved as an adjunct or for lesions not amenable to percutaneous biopsy. On balance, USCB seems to be the method of choice. The current evidence suggests it has superior diagnostic potential and is safe. With time, USCB is likely to supplant FNAC as the biopsy technique of choice, replicating that which has occurred already in other areas of medicine such a breast practice.

超声引导下粗针穿刺活检对甲状腺TI-RADS 4a类结节良恶性的鉴别诊断价值

目的探讨超声引导下粗针穿刺活检(US-CNAB)对甲状腺TI-RADS 4a类结节良恶性的鉴别诊断价值。方法选取2021-02—2023-01于郑州大学第二附属医院行US-CNAB的119例共142个甲状腺TI-RADS 4a类结节患者,以术后常规病理检查为“金标准”,评价US-CNAB鉴别诊断甲状腺TI-RADS 4a类结节良恶性的效能,统计并发症发生率。结果US-CNAB结果与术后常规病理结果的差异无统计学意义(P>0.05)。以术后常规病理检查为“金标准”,US-CNAB鉴别诊断甲状腺TI-RADS 4a类结节良恶性的准确度、灵敏度、特异度、阳性预测值、阴性预测值分别为98.15%、88.24%、95.78%、96.36%93.75%。US-CNAB后出现声音嘶哑1例,血肿6例,并发症发生率为5.88%。结论US-CNAB对鉴别甲状腺TI-RADS 4a类结节的良恶性具有较高的诊断价值。

22-gauge core vs 22-gauge aspiration needle for endoscopic ultrasound-guided sampling of abdominal masses

AIM To compare the aspiration needle(AN) and core biopsy needle(PC) in endoscopic ultrasound-guided fine needle aspiration(EUS-FNA) of abdominal masses.METHODS Consecutive patients referred for EUS-FNA were included in this prospective single-center trial. Each patient underwent a puncture of the lesion with both standard 22-gauge(G) AN(Echo Tip Ultra; Cook Medical, Bloomington, Indiana, United States) and the novel 22 G PC(Echo Tip Pro Core; Cook Medical, Bloomington, Indiana, United States) in a randomized fashion; histology was attempted in the PC group only. The main study endpoint was the overall diagnostic accuracy, including the contribution of histology to the final diagnosis. Secondary outcome measures included material adequacy, number of needle passes, and complications.RESULTS Fifty six consecutive patients(29 men; mean age 68 years) with pancreatic lesions(n = 38), lymphadenopathy(n = 13), submucosal tumors(n = 4), or others lesions(n = 1) underwent EUS-FNA using both of the needles in a randomized order. AN and PC reached similar overall results for diagnostic accuracy(AN: 88.9 vs PC: 96.1, P = 0.25), specimen adequacy(AN: 96.4% vs PC: 91.1%, P = 0.38), mean number of passes(AN: 1.5 vs PC: 1.7, P = 0.14), mean cellularity score(AN: 1.7 vs PC: 1.1, P = 0.058), and complications(none). A diagnosis on the basis of histology was achieved in the PC group in 36(64.3%) patients, and in 2 of those as the sole modality. In patients with available histology the mean cellularity score was higher for AN(AN: 1.7 vs PC: 1.0, P = 0.034); no other differences were of statistical significance.CONCLUSION Both needles achieved high overall diagnostic yields and similar performance characteristics for cytological diagnosis; histological analysis was only possible in 2/3 of cases with the new needle.

Value of contrast-enhanced ultrasound in deep angiomyxoma using a biplane transrectal probe:A case report

BACKGROUND Deep angiomyxoma(DAM)is a very rare tumor type.Magnetic resonance imaging(MRI)is considered the best imaging modality for diagnosing DAM.Computed tomography(CT)is used mainly to assess the invasion range of DAM.The value of ultrasonography in the diagnosis of DAM is still controversial.Through a literature review,we summarized the current state of ultrasonic examination for DAM and reported for the first time the contrast-enhanced ultrasound(CEUS)features of DAM seen using a biplane transrectal probe.CASE SUMMARY A 37-year-old woman presented with a sacrococcygeal mass that had gradually increased in size over the previous 6 mo.MRI and CT examinations failed to allow a definite diagnosis to be made.Transperineal core needle biopsy(CNB)guided by transrectal ultrasound and CEUS was suggested after a multidisciplinary discussion.Grayscale ultrasound of the lesion showed a layered appearance with alternating hyperechoic and hypoechoic patterns.Transrectal CEUS showed a laminated distribution of the contrast agent that was consistent with the layered appearance of the tumor on grayscale ultrasound.We performed transperineal CNB of the enhanced area inside the tumor under transrectal CEUS guidance and finally made a definitive diagnosis of DAM through histopathology.The patient underwent laparoscopic-assisted transabdominal surgery combined with transperineal surgery for large pelvic tumor resection and pelvic floor peritoneal reconstruction.No recurrence or metastasis was found at the ninemonth follow-up.CONCLUSION Transrectal CEUS can show the layered perfusion characteristics of the contrast agent,guiding subsequent transperineal CNB of the enhanced area within the DAM.

Quick-core活检针在肝脏占位性病变活检术中的应用

目的探讨Quick-core活检针在肝脏占位性病变活检术中的临床应用价值。方法通过对本院2006年9月至2009年3月18例有肝脏实质性占位病变的患者应用Quick-core活检针在超声引导下行肝肿块穿刺组织自动活检术,并对其病例进行回顾性分析,来探讨Quick-core活检针在肝脏穿刺术中的临床应用价值。结果18例活检均能获得明确的病理结果,医生评价操作方便简单,标本取得率100%,穿刺活检确诊率100%。全组无一例发生出血、感染和穿刺针道肿瘤种植等并发症。结论应用Quick-core活检针超声引导下肝肿块穿刺组织自动活检术是一种操作简便、安全性高、标本取得率高、诊断率高及微创伤、并发症少的有效方法,值得推广应用。